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FINALS > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

pre eclampsia definition

A

new HTN in pregnancy after 20 weeks gestation

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2
Q

pathology pre eclampsia

A

endothelial cell damage and vasospasm, which can affect the foetus and almost all matenal organs

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3
Q

mild PE
moderate PE
severe PE

A

Mild = proteinuria and mild/moderate HTN
Moderate = proteinuria and 160/110
Severe = proteinuria and any HTN before 34 weeks or with maternal compliocations

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4
Q

Early and late PE

A

Early = <34 weeks
Late = >34 weeks

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5
Q

features PE

A

Headache
Epi pain
Visual disturbances
Oedema
None until later stage

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6
Q

Maternal compliations PE

A

Eclampsia
CVAs
liver/renal failure
HELLP
Pulmonary oedema

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7
Q

Foetal complications PE

A

FGR
Abruption
Foetal morbidity and mortality

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8
Q

Pre ec prevention

A

Aspirin if <16 weeks and increased risk

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9
Q

Threatened miscarriage

A

Bleeding but foetus still alive, Os closed

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10
Q

Inevitable miscarriage

A

heavy bleeding, cervical os open

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11
Q

Incomplete miscarriage

A

some foetal parts passed

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12
Q

Complete miscarriage

A

all foetal tissue passed

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13
Q

Septic miscarriage

A

contents of uterus infected

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14
Q

Missed miscarriage

A

Foetus has not developed or has died but not recognised until bleeding occurs

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15
Q

Endometriosis definition

A

Presence and growth of tissue similar to endometrium outisde the uterus

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16
Q

RF endometriosis

A

Nulliparous
White
FHx
Reproductive age group
Retrograde menstruation

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17
Q

S+S endometriosis

A

Cyclical pelvic pain
Dysmennorhoea
Deep dyspareunia
Subfertility
Dyschezia
Tenderness/thickeneing behind uterus or adnexa

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18
Q

Ix endometriosis

A

Laparoscopy
Transvaginal USS
MRI if deeply infiltrating

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19
Q

Mx endometriosis

A

Pain relief
The pill
GnRH agonists
Mirena coil
Laparoscopic surgery
Hysterectomy

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20
Q

Aetiology endometrial cancer

A

Obesity
T2DM
Nulliparity
Late menopause
Oestrogen only HRT
Unopposed oestrogen

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21
Q

S+S endometrial cancer

A

Post menopausal bleeding
Abnormal bleeding
Abnormal discharge
Haematuria
Anaemia

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22
Q

Ix endometrial cancer

A

Transvaginal USS
Endometrial biopsy
Hysteroscopy

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23
Q

Mx endometrial caner

A

Surgery = hysterectomy +/- pelvic LN
Radiotherapy = adjuvant
Progesterone therapy

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24
Q

Cervical cancer aetiology

A

High risk HPV

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25
Q

Vulval cancer sx

A

itching and soreness
Persistent lump
Bleeding
Pain on passing urine

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26
Q

Ovarian cancer presentation

A

No Sx
Bloating/IBS
Abdo pain/discomfort
Change in bowel habit
Urinary frequency
Bowel obstruction

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27
Q

Obstetric cholestasis

A

Characterised by otherwise unexplained pruritus and abnormal LFTs +/- raised bile acids

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28
Q

Obstetric cholestasis causes/RF

A

later pregancy (28 weeks)
Increased oest and prog levels
genetics
South Asian
Hep C
Multiple preg
OC previously
Gallstones

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29
Q

Obsetric cholestasis presentation

A

Pruritus (palms and soles)
Fatigue
Dark urine
Pale greasy stools
Jaundice

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30
Q

Complications OC

A

Sudden stillbirth
Meconium passage
PPH

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31
Q

OC Ix

A

LFTs
Bile acids
Rise in ALP with no other abnormal LFTs = placental production

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32
Q

Mx OC

A

Ursodeoxycholic acid (UCDA)
Emollients
Antihistamines
Vitamin K 10mg/day from 36 weeks
LFTs weekly and 10 days after delivery

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33
Q

Gestational diabetes definition

A

Carbohydrate intolerance diagnosed in pregnancy which may or may not resolve after pregnancy

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34
Q

Complications GDM

A

Large for date foetus
Macrosomia
Shoulder dystocia
Congenital abnormalities
Polyhydramnios
Neonatal hypoglycaemia

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35
Q

RF GDM

A

Previous GDM
Previous macrosomic baby
BMI >30
Ethnic origin
FHX diabetes (1st degree)

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36
Q

When to screen for GDM

A

OGTT 24-28 weeks gestation
In morning after fasting = drink 75g glucose
Normal results are <5.6mmol/l fasting and <7.8mmol/l at 2 hours

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37
Q

GDM Mx

A

4 weekly USS from 28 - 36W
Fasting glucose <7, trial diet and exercise then met then insulin
Above 7 metformin
above 6 plus macrosomia start insulin and metformin
Delivery 37-39W
* 1st line
Diet management
* 2nd line
If targets not met with 1st line after 1-2 weeks, offer metformin (insulin if contraindicated)
Insulin if pre-meal glucose >6 OR 1hr post-prandial glucose >7.5
* 3rd line
Targets not met with 1+2 then add insulin
* Fasting glucose 6-6.9 and complications
Immediate insulin +/- metformin and die

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38
Q

Targets for GDM blood sugars

A

Fasting 5.3
1h after meal 7.8
2h after meal 6.4

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39
Q

Pre existing DM

A

Folic acid pre pregnancy
Sliding scale needed in delivery
Planned delivery
Retinopathy screening

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40
Q

Shoulder dystocia

A

Anterior shoulder of baby becomes stuck behind the pubic symphysis of the pelvis

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41
Q

Causes of shoulder dystocia

A

Macrosomia secondary to GDM
Previous dystocia
Obesity

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42
Q

Presentation dystocia

A

Failure of restitution
Turtle neck sign

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43
Q

Mx dystocia

A

McRoberts manoeuvre = hyperflexion of hips
Suprapubic pressuer
Episiostomy
Rubins = reach into vagina put presure on anterior shpilder
wood screw = rotate baby

44
Q

Dystocia complications

A

Foetal hypoxia (cerebal palsy)
Brachila plexus injury and bells palsy
Perineal tears
PPH

45
Q

HTN meds that should be stopped in pregnancy

A
  • ACEi
  • Angiotensin receptor blockers
  • Thiazide diuretics
46
Q

HTN meds safe in pregnancy

A
  • Labetalol
  • CCB
  • Alpha blockers
47
Q

What can undertreated or untreated hypothyroidism in pregnancy cause

A
  • Miscarriage
  • Anaemia
  • Small for gestational age
  • Pre-eclampsia
48
Q

Dose of levothyroxine in pregnancy

A
  • Needs to be increased by 25-50mcg (30-50%)
  • Titrated based on TSH level = measured every 6 weeks
  • TSH lowers in pregnancy which is why dose increased
49
Q

Safe epilepsy drugs

A
  • Levetiracetam, lamotrigine, carbamazepine
  • SV avoid
  • Phenytoin avoid (cleft)
50
Q

What is vasa praevia

A
  • Foetal blood vessels run in the membranes in front of the presenting part
  • Vessels are placed over internal cervical os, before the foetus. therefore outside the protection of the cord or placenta
51
Q

Vasa praevia presentation

A
  • Painless, moderate vaginal bleeding at the rupture of the membranes
  • Severe foetal distress
  • USS
  • Antepartum haemorrhage
  • DVE = pulsating foetal vessels seen in membranes through dilated cervix
52
Q

VP management

A
  • Immediate C section
  • Asymptomatic - corticosteroids 32 weeks, elective CS
53
Q

Type 1 and 2 VP

A
  • Type 1 = foetal vessels are exposed as a velamentous umbilical cord
  • Type 2 = foetal vessels are exposed as they travel to an accessory placental lobe
54
Q

When induction is offered

A
  • Prelabour ROM
  • Foetal growth restriction
  • Pre eclampsia
  • Obstetric cholestasis
  • DM
  • IUFD
  • Bishop score 8 or more
55
Q

Prostaglandin induction

A
  • PGE2 inserted into vagina
  • Stimulated cervix and uterus to cause osnet of labour
56
Q

Amniotomy +/- oxytocin

A
  • ARM then oxytocin infusion started within 2 hours if labour not ensued
57
Q

CRB

A
  • Silicone balloon insetred into cervix and gently inflated to dilate
58
Q

Why incidence of VTE is increased in pregnancy

A
  • Blood clotting factors are increased
  • Fibrinolytic activity reduced
  • Blood flow altered
  • Stagnation of blood and hypercoagulable states
59
Q

RF VTE in pregnancy

A
  • Smoking
  • Parity >3
  • Age >35
  • BMI >30
  • Reduced mobility
  • Multiple pregnancy
  • Pre ec
  • Varicose veins
  • FHx
  • Immobility
  • IVF
60
Q

Pulmonary embolus

A
  • Chest pain and dyspnoea
  • Tachy, raised RR and JVP
  • CXR, ABG and CT
  • CTPA or VQ
61
Q

Prophylaxis DVT/PE

A
  • from 28 weeks if 3 RF
  • 1st trimester if 4+ RF
  • LMWH continued throughout antenatal and for 6 weeks post
  • Temporarily stopped in labour
  • Mechanical if contraindicated LMWH = pneumatic compression, anti-embolism stockings
62
Q

DVT

A
  • Unilateral
  • Calf swelling
  • Dilated superficial veins
  • Tender calf
  • Oedema
  • Colour change
  • Ix = doppler USS
63
Q

Mx VTE

A
  • LMWH started immediately, before confirming diagnosis
  • Massive PE and haemodynamic compromise = unfractioned heparin, thrombolysis, surgical embolectomy
64
Q

Risks of UTI in pregancy

A
  • Preterm delivery
  • Low birth weight
  • Pre ec
65
Q

Asymptomatic bacteriuria

A
  • Bacteria in urine with no Sx
  • Tested routinely throughout pregnancy
66
Q

UTI S+S

A

Lower
- Dysuria
- Suprapubic pain
- Frequency
- Urgency
- Haematuria
Pyelo
- Fever
- Loin, suprapubic or back pain
- Vomiting
- Haematuria
- Renal angle

67
Q

Urine dipstick

A
  • Nitrites
  • Leukocytes
  • Nitrites
68
Q

Causes of UTI

A
  • E coli most common
  • Klebsiella
69
Q

Mx UTI

A
  • 7 days abx
  • Nitrofurantoin (avoid in 3rd trimester)
  • Amoxicillin
  • Cefalexin
  • Trimethoprim avoid in early pregnancy
70
Q

Cord prolapse

A
  • After rupture of membranes, UC descends below presenting part
71
Q

RF cord prolapse

A
  • Preterm labour
  • Breech
  • Polyydramnios
  • Abnormal lie
  • Twins
  • amniotomy
72
Q

Mx cord prolapse

A
  • Pushed up by finger
  • Tocolytics can be given (terbutaline)
  • All fours
  • Immediate CS
73
Q

Uterine rupture

A
  • Muscle layer of uterus (myometrium) ruptures
  • Incomplete = perimetrium remains intact
  • Complete = perimetrium ruptures and contents of uterus released into peritoneal cavity
74
Q

FR uterine rupture

A
  • Previous CS = scar is a point of weakness
  • Previous surgery
  • BMI
  • Parity
  • Age
  • Induction
75
Q

Rupture presentation

A
  • Acutely unwell mother
  • Abnormal CTG
76
Q

Rupture Mx

A
  • Maternal resuscitation with fluids and blood required
  • Emergency CS
  • Repair or removal of uterus
77
Q

Uterine inversion

A
  • Fundus inverts into uterine cavity
  • Haemorrhage, pain and shock
  • Brief attempt to push fundus up into vagina
  • Replacement with hydrostatic pressure run past a clenched fist at the introitus into the vagina
78
Q

Rubella in pregnancy

A
  • Congenital rubella syndrome caused by maternal infection
  • Pregnant women should not be given MMR vaccine as it is live = need before or after
    Features of rubella syndrome
  • Congenital deafness
  • Congenital cataracts
  • Congenital heart disease
  • Learning disability
79
Q

Chickenpox/VZV

A
  • Foetal varicella syndrome = growth restriction, microcephaly, scars, hypoplasia
  • Severe neonatal varicella infection
  • Treat with IV varicella immunoglobulins
80
Q

Features of congenital CMV

A
  • Growth restriction
  • Microcephaly
  • Hearing loss
  • Vision loss
  • LD
  • Seizures
81
Q

Triad of features of congenital toxoplasmosis

A
  • Intracranial calcification
  • Hydrocephalus
  • Chorioretinitis
82
Q

Complications of parovirus in pregnancy

A
  • Miscarriage
  • Severe foetal anaemia
  • Hydrops fetalis
  • Maternal pre ec like syndrome
83
Q

Congenital zika syndrome

A

Microcephaly
Foetal growth restriction
Ventriculomegaly

84
Q

HSV in pregnancy

A
  • Neonatal infection rare but high mortality
  • Vertical transmission at delivery
  • CS recommended
  • Exposed neonates given acyclovir
85
Q

Neonatal effects HIV

A
  • Stillbirth
  • Pre ec
  • Growth restriction
  • Prematurity
  • Vertical transmission
86
Q

Group B strep

A
  • Causes severe illness
  • Vertical transmission can be prevented by high dose IV penicillin throughout labour
  • RF = previous, positive culture, preterm labour, ROM >18hrs, maternal fever
87
Q

Toxoplasmosis

A
  • Causes LD, convulsions, spasticity’s and vision issues
  • Spiramycin started
  • Vertical transmission confirmed = pyrimethamine and sulfadiazine with folinic acid
88
Q

Grounds for TOP

A

A = continuing would risk life of woman more
B = necessary to prevent permanent injury to physical or mental health
C = not exceeded its 24th week and continuance would be greater risk
D = not exceeded 24th week and continuance would be greater to children
E = risk that if child would suffer physical or mental abnormalities as to be seriously handicapped

89
Q

Legal requirements for TOP

A
  • 2 registered medical practitioners
  • Registered practitioner in an NHS or approved hospital
90
Q

Medical TOP

A
  • Mifepristone = anti-progestogen = halts pregnancy and relaxes cervix
  • Misoprostol = prostaglandin analogue = binds to prostaglandin receptors and activates them = soften cervix and stimulate contractions
  • Used together mif then miso 36-48hrs later
  • Rh -ve women should have anti D 10 w or above
91
Q

Surgical TOP

A
  • Cervix prepared first = misoprostol, mifepristone or osmotic dilators
  • Dilation and suction
  • Dilation and forcep evacuation
92
Q

Complications TOP

A
  • Haemorrhage
  • Infection
  • Uterine perforation
  • Cervical trauma
93
Q

Adenomyosis definition

A

Presence of endometrial tissue inside the myometrium
- Associated with endometriosis and fibroids

94
Q

Adenomyosis S+S

A

Painful heavy periods, regular
Dyspareunia
1/3 asymptomatic
Exam = uterus mildly enlarged and tender

95
Q

Adenomyosis Ix

A
  • TVUSS
  • MRI
96
Q

Adenomyosis Mx

A

No contraception wanted
- TXA when no associated pain
- Mefenamic acid when associated pain
Contraception
- Mirena coil
- COP
- Progesterone’s

97
Q

Atrophic vaginitis

A
  • Dryness and atrophy of the vaginal mucosa related to lack of oestrogen
  • Occurs in women entering menopause = oestrogen falls and mucosa is thinner, less elastic, dry
98
Q

AV S+S

A
  • Itching and dryness
  • Dyspareunia
  • Bleeding due to localised inflammation
    Exam
  • Pale mucosa
  • Thin skin
  • Reduced folds
  • Erythema and inflammation
  • Dryness
  • Sparse pubic hair
99
Q

AV Mx

A
  • Lubricant
  • Topical oestrogen
100
Q

Causes of infertility

A
  • Ovulation issues
  • Male factor problems
  • Sperm unable to reach egg = tubal, coital, cervical
  • Implantation
101
Q

General advice for fertility

A
  • 400mcg folic acid a day
  • Health = BMI, smoking, alcohol
  • Intercourse every 2-3 days
102
Q

Primary care Ix infertility

A
  • BMI
  • Chlamydia screen
  • Semen analysis
  • Female hormone testing
  • Rubella immunity
103
Q

Missing 1 pill when the pill is >24hrs late

A

<72hrs since last pill was taken
- Take missed pill ASAP even if 2 in 1 day
- No extra protection needed

104
Q

Missing >1 pill (>72hrs since last pill)

A
  • take most recent pill ASAP
  • Additional contraception for 7 days
  • if days 1-7 emergency contraception
  • 8-14 no emergency contraception
  • 15-21 no emergency contraception and back to back
105
Q
A

FINALS (31 decks)

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